National Strategy Forum Q&A

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There is no direct equivalent program for adults. However, a range of other services offer psychoeducation and support for individuals and families/supports, including while waiting to engage with treatment. Some examples of initiatives which are available to adults include: Butterfly Foundation’s ‘Emerging’ program, Eating Disorders Families Australia’s ‘Fill the Gap’ carer counselling program, Eating Disorder Victoria’s workshops and group programs and peer mentoring program, and Eating Disorder Queensland’s peer support sessions. For treatment services for adults in Queensland, contact the Queensland Eating Disorder Service (QuEDS) or Eating Disorders Queensland.

Q: Why does the Next Steps Program [run by Butterfly Foundation] not provide support to people with ARFID?

A: We [Butterfly Foundation] know that there is a significant gap in the area of providing tailored support for ARFID - this is certainly something that Butterfly is passionate about, and will be a focus in our future endeavours/new support options to ensure that there is more adequate support available.

Prior to launching Next Steps we underwent a significant evaluation process, including a literature review examining the evidence-based practice for all eating disorders - and found that there were important differences in the management of ARFID, and that it would be more suitable to have a tailored approach specifically for individuals and their carers impacted by ARFID.

We are hoping that our program can pave the way in increasing the scope and delivery of virtual intensive outpatient programs in the future, and that our learnings will support the development of a structured program particularly targeted at managing ARFID.

Response provided by Grace Collison, Clinical Program Manager for Butterfly Foundation’s Next Steps program. For more information, please contact nextsteps@butterfly.org.au.

Q: Why is BMI included in eligibility criteria for Butterfly's Next Steps program?

A: To clarify, we [Butterfly Foundation] do not have BMI requirements in terms of eligibility to the program - we know that the BMI does not adequately capture the severity of an individual’s experience, and are firm believers that this is a largely problematic and outdated model. In saying that, we are asking the primary referrer/medical professional responsible for medical monitoring in the community to monitor the participant’s weight, to ensure that there is no significant changes that indicate deterioration or medical de-stabilisation.

It is important to note that this would not result in an automatic discharge/ineligibility from our program. However, it provides an indication to us that we might need to provide some more wrap-around support/explore medical risk, to ensure that the participant is safe and able to continue engaging in a virtual program.

Response provided by Grace Collison, Clinical Program Manager for Butterfly Foundation’s Next Steps program. For more information, please contact nextsteps@butterfly.org.au.

for example, telling a client with ED to go on a more restrictive diet without consulting with GPs or dietitians.

Supervision (individual and group), mentoring, and communities of practice can be helpful tools here, and ensuring that people are seeking support from an eating disorders-informed clinician. Some people may not know about the National Strategy and evidence-based guidelines. We highly encourage you to help others to engage in best practice, and access resources to support them to do so where you feel you can. You might also support your colleagues to upskill in this area by promoting key resources and training, or bringing this topic to any group/peer supervision or team meetings that are held. If you feel that there is potential harm to the client, we recommend following your professional guidelines.

We would recommend being guided by eating disorder safe principles specifically for individuals in higher weights. This can reduce the potential harm for the person. It is important for the service (and clinicians) to have a clear understanding of the rationale for weighing and by who (medical monitoring, experiential challenge, cognitive restructurings) and the impact this may have with disorder eating/ eating disorder presentation and weight stigmatising beliefs.

Services (and clinicians) should also allow the individual to have choice in how treatment should proceed including declining aspects of the treatment, choosing not to see the number nor discussing numbers in the session (blind weighing).

'There are many alternative ways of describing foods which avoid using dichotomies such as healthy/unhealthy or good/bad. To some extent, the word choices you make will depend on your context and the people you are communicating with (having regard to their age, culture, socioeconomic position and other factors). 

• As a general rule, it can be helpful to focus on using descriptive names for foods without conferring positive or negative attributes, e.g. calling foods what they are, such as "pizza", "broccoli", "chocolate", "eggs", "cherries." 
• If your role involves helping people to learn about foods, you could also focus on experiential terms, such as "crunchy," "green", "sweet", "cold", "filling."  
• If your role involves nutrition counselling, you could help a person to understand the different effects that foods have on their health, such as "fibre helps you feel full and helps your digestive system move everything through," or "sharing a bowl of chips with friends helps you feel included which is great for your social and emotional wellbeing," or "eating a variety of foods helps to meet our health needs."

We can also talk about people's relationship with food, and ways to support this relationship in a positive way. This might include having a flexible relationship with food that is not bound by rules, being able to eat without stress and in ways that feel supportive, or practicing intuitive eating (if appropriate). 

Protective factors refer to those parts of a person's inner or outer world that we can nourish and nurture as part of helping to lower their risk of developing an eating disorder. This includes a broad range of factors such as bodily attunement, high self-esteem, positive self-image, the ability to practice self-compassion, media literacy skills, appreciation of body diversity, positive family connectedness, regular positive family mealtimes, experiences of weight inclusive healthcare, involvement in sport, and food security. You can read more about protective factors on our Risk & Protective factors webpage.

Bolstering protective factors through professional practice involves finding ways to help a person or a group to build on what they already have, or to develop new skills or attitudes. This might be done in the context of therapy for psychological factors such as body image, self-esteem, self-compassion and self-concept. Several evidence-based group programs exist for building media literacy and appreciation of body diversity. Professionals who work with families could focus on building family systems that can support positive mealtimes and overall connectedness. Some workers may also be able to assist clients to access food relief and/or financial counselling as part of improving their food security. 

All health professionals can play a role in providing weight inclusive healthcare as a key protective factor against eating disorders. For more information and practice tips, see the NEDC page on weight stigma.

The BHN Health Promotion team host a Community of Practice to support the health promotion sector to apply a size inclusive lens to their practice.

We also host workshops with health promotion teams who are interested in learning more.

If you are interested in joining the community of practice or want to work with us to support your team to apply a size inclusive lens to your work, contact us at healthpromotion@bhn.org.au

Young children aged 2-7 years best understand concrete information. Nutrition concepts are abstract, we cannot see, touch, or taste the nutrients in food so like algebra, nutrition is harder to conceptualise.

Young children benefit from activities that allow them to explore food with their five senses - sight, smell, hearing, touch and taste (without pressure to eat it or learning about what the food does in our bodies!). Activities like gardening, cooking or sensory play with food are great ways for children to explore food.

Children aged 7-12 years, can begin to grasp the concept of food groups, such as dairy, grains, vegetables and fruit. It is not necessary to focus on specific nutrients (such as, calcium) in food. They still benefit from activities that allow them to explore food with their five senses.

Teenagers are able to think abstractly and reason logically. They can learn about health and nutrition in a way that is empowering and non-judgmental, for example, 'fibre is in wholegrains, vegetables and fruit and aids digestion'. Teenagers also benefit from learning to plan and cook meals.

Full question: How have you supported your lived experience workforce as your service has expanded? What have been your key successes or challenges in supporting employee professional development and wellbeing?

Response: 

As the team expanded, we appointed a Team Leader to ensure appropriate training and support of all new staff. Work instructions were developed for training purposes and there is a bi-weekly 'team huddle' to assist with communication and support needs. Each staff member working with the BEP, has a monthly meeting with the Team Leader as well as quarterly with Management. This is in addition to external Professional supervision, specialised group supervision, monthly peer review for group programs and opportunities for debrief and shared care. The BEP staff also work within a wider multi-disciplinary team where emphasis is placed on upskilling and Professional Development.

Our key successes include the successful establishment of the new suite of services, recruitment of four additional peer workers (including a carer peer), and opportunities for networking across the sector. Staff have also been supported in completing mandatory training such as Gatekeeper Suicide Prevention  and Mental Health First Aid.

Challenges have included the need for additional promotion as a service which provides support, to young people, males and gender-diverse individuals as this has not been something that we have previously been known for. This process can sometimes be frustrating for staff and so we work to manage expectations and provide support wherever we can. Another challenge for peer workers is getting the balance right between the purposeful disclosure expected within a peer work role and maintaining professional boundaries. We address this through our training and ongoing support supervision mechanisms.